Post on 25-Feb-2016
description
transcript
DIABETES AND THE UROLOGISTArch Enemies!
Dr. Kenneth Thomas, MDDiabetes Support Group
Starkville, MS7/10/12
Introduction
25.8 million children and adults in the United States—8.3% of the population—have diabetes
10.9 million, or 26.9% of all people in the 65+ age group have diabetes
Average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes!
Introduction
Other Problems Heart disease Stroke Neuropathy Blindness High blood pressure Amputation Elevated lipid profiles
Introduction
What we’ll talk about Bladder Dysfunction – Anything from “I
pee too much” to “I can’t pee” Urinary Incontinence BPH – older gentlemen with difficulty
voiding UTIs ED
Introduction
What we’ll talk about Hypogonadism – “Low T” Diabetic Nephropathy – fancy words for
the kidneys not working like they used to Renal Transplantation Surgery
Bladder Dysfunction
Over half of diabetics have bladder “issues”
Diabetic Cystopathy – poor bladder sensation, poor contractility and increased post-void residuals (increased incidence the longer a patient has had DM)
39-61% of patients have urgency +/- frequency
Bladder Dysfunction
What can diabetic cystopathy (elevated residuals) lead to? UTIs Vesicoureteral reflux and hydronephrosis Kidney damage Kidney stones sepsis
Bladder Dysfunction
What can we do?! Urodynamics Conservative (pelvic floor training,
intermittent catheterization) Pharmacological Surgical
Urinary Incontinence
Almost double the risk compared to those without DM
Can be 3 different types of incontinence Urge Stress Overflow
Urinary Incontinence
Treatments? Weight loss and DM control Conservative (Kegels, etc) Pharmacological Surgical
BPH
There is a direct relationship between prostate growth and DM/obesity
How does this work?? …We don’t really know
UTIs
Double the risk (in postmenopausal women with DM)
If taking DM meds, triples or quadruples the risk!
Sometimes the kidney also is infected (pyelonephritis) possibly leading to decreased renal function
UTIs
Can also lead to renal abscesses or papillary necrosis
Treatments Prophylaxis or intermittent treatment DM control Estrogen Yogurt, cranberry juice Low post-void residuals
ED
Risks factors DM Obesity High blood pressure Lipid disorders Smoking Heart disease
ED
20-71% of patients with DM have ED
Smoking doubles the risk
The worse the DM, the worse the ED
ED
Treatments Meds Intraurethral pellet Injections Penile Pump Penile Prosthesis
Hypogonadism
Low T can be a predictor of upcoming DM!
Testosterone decreases with obesity and age
Testosterone replacement can improve sensitivity to insulin
It has also been shown to actually delay the progression of DM, the metabolic syndrome, ED, and voiding dysfunction
Diabetic Nephropathy
Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008
In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States
20-30% of people with DM will be affected by this
Diabetic Nephropathy
If creatinine is above 1.5, there’s a linear increase in morbidity and mortality (age is the best independent predictor long term)
Can ultimately lead to end-stage renal failure…which leads to worsening cardiovascular disease
Treatments Hemodialysis Peritoneal dialysis Kidney transplant
Renal Transplantation
16% of DM patients on HD ultimately undergo renal transplant
Selection criteria Age < 65 No cardiovascular or cerebrovascular
disease No sepsis No “life-limiting” comorbidity
On the rise – simultaneous kidney and pancreas transplant
Surgery
DM is the most common surgical endocrinopathy
Optimize glucose control (affects postop outcomes)
Summary
Diabetes is our enemy! Better control means better
outcomes and slowing the progression down
Team approach – family physician, support groups, dieticians, etc
“Am I part of the cure or am I part of the disease?” - Coldplay
Questions/Comments
References
American Diabetes Association “Diabetes and the urologist: a
growing problem”, Goldstraw, BJU International, 2006.